2011 Meaningful Use Testing

Approach Review

HL7 V2 Immunization and Lab Reporting Test

Procedures Issues

Robert Snelick, NIST (rsnelick@nist.gov)

HL7 WGM—May 2010

1
Purpose
• Explain issues NIST encountered in creating tests for
meaningful use
– HL7 V2 Immunization (EHR to Public Health Registry)
– HL7 Lab Reporting (EHR to Public Health)
• Describe NIST approach for creating test procedures
• Describe NIST approach for assessment
• Seek feedback and guidance from HL7 on approach
• Review NIST selected test elements
– Seek input on the selections
– Seek answer to specific questions


2
IFR Criteria
• Submission to immunization registries [170.302(m)]
– For the immunization test procedure, the vendor is
required to record, retrieve, and transmit data
– Transmit: evaluates the capability of the EHR to
transmit the recorded immunization information to an
immunization registry in either HL7 2.3.1 or HL7 2.5.1
format including the appropriate HL7 CVX codes
– Create conformant immunization message
• Reportable lab results [170.306(g)]
– Evaluates the capability to receive, store and retrieve a
LOINC-encoded laboratory test result in the EHR.
– Transmit: evaluates the capability of the EHR to
electronically transmit the received LOINC-encoded
laboratory test result in a conformant HL7 v2.5.1
format
– Create conformant lab result message

3
Issues for Creating Test Procedures
• Background
– NIST needs to test based on what is given in the IFR criteria
– Criteria is not that specific (i.e., HL7 version and value set)
– We need to test to the intent of the criteria
• Issues
– HL7 V2 is a framework for building specifications
• IFR criteria did not specify constraints on message types
• IFR criteria did not specify HL7 V2 IGs
– We can’t add additional requirements
– However, we have to identify the elements to test
• “minimal but useful” approach
• without creating an implementation guide
• we understand the potential ramifications of NIST
creating an “implied” implementation guide and we do
not want that
• we need to strike the right balance
• guidance from IGs and domain experts

4
NIST Approach to Identifying Elements
to Test
• Start with what is specified in the IFR (e.g., 2.5.1 and
CVX)
• Derive explicit requirements:
– CVX  RXA segment  VXU message
– VXU  MSH and PID segment
– RXA segment  ORC segment
– PID segment  Patient Name Field
– Etc.
• Derive implicit requirements
– To meet the intent of meaningful use
– Should birth date & vaccine lot number be sent to
registry?
– This is hard and awkward
– “minimal but useful” approach
– Assessment is different from explicit requirements

5
Immunization Data Conformance
Assessment
Patient Information Vaccine Information
and MU Criteria

per HL7 2.3.1
• Patient Identifier •Vaccine Code (CVX)
Required

• Patient Name •Date/Time

• Administered
 •Amount Administered

•Patient Date of Birth •Vaccine Lot Number

per HL7 2.3.1

•Patient Administrative •Vaccine

Optional

Sex/Gender Manufacturer
•Patient Address
•Patient Telephone
•

Conformance Assessment
Required – Test data shall be populated, correct and conformant
Optional – If populated, test data shall be correct and conformant

6 6
Validation Reports

and MU Criteria Conformance Assessment

per HL7 2.3.1
Test data shall be populated, correct and syntactically/semantically
Required

conformant

Validation Report Messages

-test data missing or incorrect = Error
-syntactically or semantically incorrect = Error

Conformance Assessment
If populated, test data shall be correct and syntactically/semantically
per HL7 2.3.1

conformant
Optional

Validation Report Messages

-test data not populated = Warning
-test data incorrect = Error
-syntactically or semantically incorrect = Error

Error – must be resolved to achieve MU conformance

Warning –informative only; not required to resolve for MU conformance

7 7
ATCB Role in Interpreting Validation
Reports
Conformance Assessment
per HL7 2.3.1
Test data shall be populated, correct and syntactically/semantically
Required

conformant

ATCB Interpretation of Validation Report

-No Errors on validation report in order to achieve MU conformance
-

Conformance Assessment
If populated, test data shall be correct and syntactically/semantically
per HL7 2.3.1

conformant
Optional

ATCB Interpretation of Validation Report

-No Errors on validation report in order to achieve MU conformance
-Warnings for missing test data are ‘reasonable’ as evaluated by the ATCB

Error – must be resolved to achieve MU conformance

Warning –informative only; not required to resolve for MU conformance

8 8
Usage Code Interpretation and
Assessment
HL7 Usage Meaningful Use Interpretation Validation
R R required by standard (absolute requirement) Strict conformance testing
(Error reported)
O RMU-0 required by IFR (explicit criteria specified by Strict conformance testing
meaningful use or derived based on specified (Error reported)
O RMU-1 required for criteria)
meaningful meaningful use—implicit criteria Conformance testing with
based on the intent of meaningful use criteria latitude from testing
O Not Everything
(meeting theelse is optional
“minimal but useful approach). If populated strict
organization (Errorconformance
reported);
Specified testing (Error reported)
For example vaccine lot number, important forvendor needs to articulate why
public health if a problem is discovered with a field not populated based on
certain vaccine “batch” application role

Optional per HL7 maps to RMU-0, RMU-1, or not specified

9
Immunization VXU V04 Message
Segment 2 . 3 . 1 2 . 5 . 1 IG MU 2 . 3 . 1 MU 2 . 5 . 1 Usage¹ Meaning
MSH R R R R R
R HL7 Required
SFT NA O NA O O O HL7 Optional
PID R R R R R RE HL7 Required or Empty
PD1 O O RE O O NA Not Specified
NK1 O O RE O O RMU-0 Required for meaningful use—absolute
PV1 O O RE O O RMU-1 requirement
Required for meaningful use—latitude given
PV2 O O NA O O in assessment
GT1 NA O NA O O
IN1 O O O O O
IN2 O O O O O
IN3 O O O O O
ORC² O O RE³ O RMU-0 ¹ Conformance checks for MU are conducted for R,
TQ1 NA O NA O O RMU-0, and RMU-1 elements.
TQ2 NA O NA O O
² RXA is the segment that carries the vaccine
RXA² O O R RMU-0 RMU-0
information using the CVX code system. Therefore
RXR O O RE O O the RXA segment is required for meaningful use
OBX O O RE O O certification. In HL7 2.5.1 if RXA is sent then an
NTE O O RE O O ORC must also be sent. Therefore the ORC
segment is required for meaningful use certification.

³ Should be R in IG if RXA is sent (comment sent)

10
Notes on Implementation Guides and
RE Usage
• Implementation Guide profiles many elements as RE-Required
or Empty
• Required or Empty essentially means that the system must
implement this functionality
• At runtime they must populate this element if data is available
• For the MU use cases we are dealing with EHR sending
systems
• Since we specify the data sets as part of the test case the data
is known by the EHR system
• Therefore for MU we don’t have the concept of “RE”; they are
promoted “R” as part of the testing process
• Test data is integral to the testing process; tests are driven
from the use case/test data—differs from IG

11
Implementation Guides vs. Meaningful Use
Testing
• Implementation guides typically covers more than one use case (as is the
case with here)
– i.e., the scope is much broader then anyone given test case
• Without the context of specific test cases (test data) testing with respect
to the implementation guide is challenging
– Message validation without the context of test data renders all elements
with RE usage essentially optional with respect to testing—this isn’t
very useful for testing
– Most elements are specified as RE in implementation guides
– Providing test data for all potential instances is not practical
– MU provides a useful (typical) small subset to test
• Important distinction between MU testing and IGs
– IG instructs to implement; testing is realized with test cases
– MU testing is driven by the test data to evaluate certain aspects
– MU tests are in alignment with IG; tests a small subset of possible uses
described in implementation guides
– Although it can be implied that the test data we supply implicitly is
specifying a MU IG, we believe it is just a stepping stone to
implementation guide adoption


12
Example Message
• With implied Criteria (RMU-1)
•MSH|^ ~\&|EHR Application|EHR Facility|PH Application|PH Facility|20100514104255||VXU^V04^VXU_V04|NIST-
100514104255228|P|2.5.1
•PID|||9817566735^^^MPI &2.16.840.1.113883.19.3.2.1&ISO^MR||Johnson^Philip||19840526|M||2106-3^White^HL70005|
3345 Elm Street^^Aurora^CO^80011^USA^M||(303)554-8889^^^^^303^5548889|||||||||N^Not Hispanic or
Latino^HL70189
•ORC|RE
RXA|0|1|201002241000|201002241000|52^Hepatitis A^CVX|1|||||||||HAB9678V1||SKB^GLAXOSMITHKLINE^MVX

•
• Without implied Criteria
MSH|^~\&|||||20100514104255||VXU^V04^VXU_V04|NIST-100514104255228|P|2.5.1
PID|||9817566735^^^MPI&2.16.840.1.113883.19.3.2.1&ISO^MR||Johnson^Philip
ORC|RE
RXA|0|1|201002241000|201002241000|52^Hepatitis A^CVX|1

13
MSH Segment Specification
SEQ Element Name 2 .5 .1 IG VXU IG ORU MU
MSH 1 Field Separator R R R R
MSH 2 Encoding Characters R R R R
MSH 3 Sending Application O RE R RMU-1
MSH 4 Sending Facility O RE R RMU-1
MSH 5 Receiving Application O RE R RMU-1
MSH 6 Receiving Facility O RE R RMU-1
MSH 7 Date/Time Of Message R R R R
MSH 8 Security O O O O
MSH 9 Message Type R R R R
MSH 10 Message Control ID R R R R
MSH 11 Processing ID R R R R
MSH 12 Version ID R R R R
MSH 13 Sequence Number O O O O
MSH 14 Continuation Pointer O O O O
MSH 15 Accept Acknowledgment Type O RE CE O
MSH 16 Application Acknowledgment Type O RE CE O
MSH 17 Country Code O O R O
MSH 18 Character Set O O O O
MSH 19 Principal Language Of Message O O O O
MSH 20 Alternate Character Set O O O O
MSH 21 Message Profile Identifier O O R O

14
Immunization PID Segment
Specification
SEQ ELEMENT NAME Usage IG MU SEQ ELEMENT NAME Usage IG MU
PID 1 Set ID - PID O RE O PID 20 Driver's License Number - B X O
PID 2 Patient ID B X O PID 21 Patient
Mother's Identifier O X O
PID 3 Patient Identifier R R R PID 22 Ethnic Group O RE RMU-1
PID 4 List
Alternate Patient ID - B X O PID 23 Birth Place O O O
PID 5 PID
Patient Name R R R PID 24 Multiple Birth Indicator O RE O
PID 6 Mother’s Maiden Name O RE O PID 25 Birth Order O CE O
PID 7 Date/Time of Birth O R RMU-1 PID 26 Citizenship O O O
PID 8 Administrative Sex O RE RMU-1 PID 27 Veterans Military Status O O O
PID 9 Patient Alias B X O PID 28 Nationality B O O
PID 10 Race O RE RMU-1 PID 29 Patient Death Date and Time O RE O
PID 11 Patient Address O RE RMU-1 PID 30 Patient Death Indicator O CE O
PID 12 County Code B X O PID 31 Identity Unknown Indicator O O O
PID 13 Phone Number - Home O RE RMU-1 PID 32 Identity Reliability Code O O O
PID 14 Phone Number - BusinessO O O PID 33 Last Update Date/Time O RE O
PID 15 Primary Language O O O PID 34 Last Update Facility O CE O
PID 16 Marital Status O O O PID 35 Species Code C O O
PID 17 Religion O O O PID 36 Breed Code C O O
PID 18 Patient Account Number O O O PID 37 Strain O O O
PID 19 SSN Number - Patient B X O PID 38 Production Class Code O O O
PID 39 Tribal Citizenship O O O

15
Immunization RXA Segment
Specification
SEQ
RXA 1
Element Name
Give Sub-ID Counter
Usage
R
IG
R
MU
R
RXA 2 Administration Sub-ID Counter R R R
RXA 3 Date/Time Start of Administration R R R
RXA 4 Date/Time End of Administration R RE R
RXA 5 Administered Code R R R
RXA 6 Administered Amount R R R
RXA 7 Administered Units C CE C
RXA 8 Administered Dosage Form O O O
RXA 9 Administration Notes O RE O
RXA 10 Administering Provider O RE O
RXA 11 Administered-at Location C RE O
RXA 12 Administered Per (Time Unit) C O O
RXA 13 Administered Strength O O O
RXA 14 Administered Strength Units O O O
RXA 15 Substance Lot Number O RE RMU-1
RXA 16 Substance Expiration Date O CE O
RXA 17 Substance Manufacturer Name O RE RMU-1
RXA 18 Substance/Treatment Refusal Reason O C O
RXA 19 Indication O O O
RXA 20 Completion Status O RE O
RXA 21 Action Code - RXA O RE O
RXA 22 System Entry Date/Time O O O
RXA 23 Administered Drug Strength Volume O O O
RXA 24 Administered Drug Strength Volume Units O O O
RXA 25 Administered Barcode Identifier O O O
RXA 26 Pharmacy Order Type O O O

16
Lab Results ORU R01 Message
Segment HL7 2 . 5 . 1 IG² MU 2 . 5 . 1 Usage¹ Meaning
MSH R R R
R HL7 Required
SFT O R O O HL7 Optional
PID O R RMU-1 RE HL7 Required or Empty
PD1 O O O NA Not Specified
NTE O RE O RMU-0 Required for meaningful use—absolute requirement
NK1 O RE O RMU-1 Required for meaningful use—latitude given in assessment
PV1 O ³RE/R⁴ O
PV2 O RE O
ORC O CE O
OBR R R R ¹ Conformance checks for MU are conducted for R, RMU-0, and RMU-
NTE O RE O 1 elements.
TQ1 O RE/R O
² Lab Result Sender Usage Profile
TQ2 O O O
CTD O O O ³ RE/R  Group/Segment Usage Binding Interpretation
OBX R CE/R RMU-0
⁴ R if visit group is present
NTE O CE/RE O
FTI O O O
CTI O O O
SPM O CE/R O
OBX O CE/RE O
DSC O X O

17
Lab Results PID Segment Specification
SEQ ELEMENT NAME Usage IG MU PID 20 Driver's License Number - B X O
PID 1 Set ID - PID O R O PID 21 Patient
Mother's Identifier O O O
PID 2 Patient ID B X O PID 22 Ethnic Group O RE RMU-1
PID 3 Patient Identifier List R R R PID 23 Birth Place O O O
PID 4 Alternate Patient ID - B X O PID 24 Multiple Birth Indicator O O O
PID 5 PID
Patient Name R R R PID 25 Birth Order O O O
PID 6 Mother’s Maiden Name O RE O PID 26 Citizenship O O O
PID 7 Date/Time of Birth O RE RMU-1 PID 27 Veterans Military Status O O O
PID 8 Administrative Sex O RE RMU-1 PID 28 Nationality B X O
PID 9 Patient Alias B X O PID 29 Patient Death Date and Time O RE O
PID Race O RE RMU-1 PID 30 Patient Death Indicator O RE O
10
PID Patient Address O RE RMU-1 PID 31 Identity Unknown Indicator O RE O
11
PID County Code B X O PID 32 Identity Reliability Code O O O
12
PID Phone Number - Home O RE RMU-1 PID 33 Last Update Date/Time O RE O
13
PID Phone Number - Business O RE O PID 34 Last Update Facility O CE O
14
PID Primary Language O O O PID 35 Species Code C RE O
15
PID Marital Status O O O PID 36 Breed Code C O O
16
PID Religion O O O PID 37 Strain O O O
17
PID Patient Account Number O C O PID 38 Production Class Code O O O
18
PID SSN Number - Patient B X O PID 39 Tribal Citizenship O O O
19

18
Lab Results OBR Segment Specification
SEQ Element Name 2.5.1 IG MU SEQ Element Name 2.5.1 IG MU
OBR 1 Set ID ‑ OBR O R RMU-1 OBR 26 Parent Result O CE O
OBR 2 Placer Order Number C RE O OBR 27 Quantity/Timing B X B
OBR 3 Filler Order Number C ? RMU-1 OBR 28 Result Copies To O RE O
OBR 4 Universal Service Identifier R R** R OBR 29 Parent O CE O
OBR 5 Priority – OBR X X X OBR 30 Transportation Mode O X O
OBR 6 Requested Date/Time X X X OBR 31 Reason for Study O RE RMU-1
OBR 7 Observation Date/Time C R RMU-1 OBR 32 Principal Result Interpreter O RE O
OBR 8 Observation End Date/Time O CE O OBR 33 Assistant Result Interpreter O O O
OBR 9 Collection Volume O X O OBR 34 Technician O O O
OBR 10 Collector Identifier O O O OBR 35 Transcriptionist O O O
OBR 11 Specimen Action Code O O O OBR 36 Scheduled Date/Time O O O
OBR 12 Danger Code O O O OBR 37 Number of Sample Containers * O X O
OBR 13 Relevant Clinical Information O RE RMU-1 OBR 38 Transport Logistics of Collected O X O
OBR 14 Specimen Received Date/Time B X B OBR 39 Sample
Collector's Comment * O O O
OBR 15 Specimen Source B X B OBR 40 Transport Arrangement O X O
OBR 16 Ordering Provider O RE O OBR 41 Responsibility
Transport Arranged O X O
OBR 17 Order Callback Phone Number O RE O OBR 42 Escort Required O X O
OBR 18 Placer Field 1 O O O OBR 43 Planned Patient Transport O X O
OBR 19 Placer Field 2 O O O OBR 44 Comment
Procedure Code O O O
OBR 20 Filler Field 1 O O O OBR 45 Procedure Code Modifier O O O
OBR 21 Filler Field 2 O O O OBR 46 Placer Supplemental Service Info O O O
OBR 22 Results Rpt/Status Chng - C R RMU-1 OBR 47 Filler Supplemental Service O O O
OBR 23 Date/Time
Charge to Practice O O O OBR 48 InformationNecessary Duplicate
Medically C O C
OBR 24 Diagnostic Serv Sect ID O RE O OBR 49 Proced Handling
Result O O O
OBR 25 Result Status C R RMU-1 OBR 50 Parent Universal Service O O O
Identifier

19
Lab Results OBX Segment Specification
SEQ Element Name 2.5.1 IG MU
OBX 1 Set ID – OBX O R RMU-1
OBX 2 Value Type C CE RMU-1
OBX 3 Observation Identifier R R R
OBX 4 Observation Sub-ID C CE RMU-1
OBX 5 Observation Value C CE RMU-1
OBX 6 Units O CE RMU-1
OBX 7 References Range O RE RMU-1
OBX 8 Abnormal Flags O CE O
OBX 9 Probability O O O
OBX 10 Nature of Abnormal Test O O O
OBX 11 Observation Result Status R R R
OBX 12 Effective Date of Reference Range O O O
OBX 13 Values
User Defined Access Checks O O O
OBX 14 Date/Time of the Observation O CE RMU-1
OBX 15 Producer's Reference O O O
OBX 16 Responsible Observer O O O
OBX 17 Observation Method O RE CMU-1
OBX 18 Equipment Instance Identifier O O O
OBX 19 Date/Time of the Analysis O RE RMU-1
OBX 20 Reserved for harmonization with V2.6 NA X NA
OBX 21 Reserved for harmonization with V2.6 NA X NA
OBX 22 Reserved for harmonization with V2.6 NA X NA
OBX 23 Performing Organization Name O R RMU-1
OBX 24 Performing Organization Address O R RMU-1
OBX 25 Performing Organization Medical O RE O
Director

20
MSH Segment/Data Layout in Test
Procedure
Location Data Element Test Data ** System
Dependent
Data
Comments Table # VXU 2 . 3 . 1
Usage
VXU 2 . 5 . 1
Usage
MSH-1 Field Separator | FIXED   Required Required
MSH-2 Encoding Characters ^ ~\ & FIXED   Required Required
MSH-3 Sending Application*   **     Required Required
MSH-3.1 Namespace ID     Conditional Conditional
MSH-3.2 Universal ID     Conditional Conditional
MSH-3.3 Universal ID Type   HL70301 Conditional Conditional
MSH-4 Sending Facility*   **     Required Required
MSH-4.1 Namespace ID     Conditional Conditional
MSH-4.2 Universal ID     Conditional Conditional
MSH-4.3 Universal ID Type   HL70301 Conditional Conditional
MSH-5 Sending Facility*   **     Required Required
MSH-5.1 Namespace ID     Conditional Conditional
MSH-5.2 Universal ID     Conditional Conditional
MSH-5.3 Universal ID Type   HL70301 Conditional Conditional
MSH-6 Sending Facility*   **     Required Required
MSH-6.1 Namespace ID     Conditional Conditional
MSH-6.2 Universal ID     Conditional Conditional
MSH-6.3 Universal ID Type   HL70301 Conditional Conditional
MSH-7 Date/Time of Message   Current time of the   Required Required
MSH-9 Message Type   SUT
    Required Required
MSH-9.1 Message Code VXU FIXED HL70076 Required Required
MSH-9.2 Event Type V04 FIXED HL70003 Required Required
MSH-9.3 Message Structure VXU_V04 FIXED HL70354 Optional Required
MSH-10 Message Control ID   Created by the SUT   Required Required
MSH-11 Processing ID P FIXED HL70103 Required Required
MSH-12 Version ID 2 . 3. 1 FIXED HL70104 Required Not Applicable
MSH-12 Version ID 2 . 5. 1 FIXED HL70104 Not Applicable Required

21
MSH Segment/Data Layout in
Spreadsheet
MSH #1  
Location Data Element
 
Test Data
 
System Dependent
 
Comments
 
Table #
Immunizatio Immunizatio
n
VXU 2.3.1
n
VXU 2.5.1
MSH-1 Field Separator | Data
  FIXED   R R
MSH-2 Encoding Characters ^~\&   FIXED   R R
MSH-3 Sending Application         RMU-1 RMU-1
MSH-3.1 Namespace ID   EHR Application See the Notes   CMU-1 CMU-1
MSH-3.2 Universal ID   tab for   CMU-1 CMU-1
MSH-3.3 Universal ID Type     handling
the HD HL70301 CMU-1 CMU-1
MSH-4 Sending Facility     datatype
    RMU-1 RMU-1
MSH-4.1 Namespace ID   EHR Facility See the Notes   CMU-1 CMU-1
MSH-4.2 Universal ID     tab for   CMU-1 CMU-1
MSH-4.3 Universal ID Type     handling
the HD HL70301 CMU-1 CMU-1
MSH-5 Sending Facility      datatype   RMU-1 RMU-1
MSH-5.1 Namespace ID   PH Application See the Notes   CMU-1 CMU-1
MSH-5.2 Universal ID     tab for   CMU-1 CMU-1
MSH-5.3 Universal ID Type     handling
the HD HL70301 CMU-1 CMU-1
MSH-6 Sending Facility      datatype   RMU-1 RMU-1
MSH-6.1 Namespace ID   PH Facility See the Notes   CMU-1 CMU-1
MSH-6.2 Universal ID     tab for   CMU-1 CMU-1
MSH-6.3 Universal ID Type     handling
the HD HL70301 CMU-1 CMU-1
MSH-7 Date/Time of Message     datatypetime  
Current RMU-1 R
of the SUT
MSH-9 Message Type         R R
MSH-9.1 Message Code VXU   FIXED HL70076 R R
MSH-9.2 Event Type V04   FIXED HL70003 R R
MSH-9.3 Message Structure VXU_V04   FIXED HL70354 O R
MSH-10 Message Control ID     Created by the   R R
SUT
MSH-11 Processing ID P   FIXED HL70103 R R
MSH-12 Version ID 2.3.1   FIXED HL70104 R X
MSH-12 Version ID 2.5.1   FIXED HL70104 X R

22
Test Data Categories
• Test Data
– Data provided by NIST for the test case in which the vendor is
expected to use to populate with exactly content
– Validation will be on exact content
– Test data is Hepatitis A, we validate that:
• RXA-5.1 = 52
• RXA-5.2 = Hepatitis A
• RXA-5.3 = CVX or HL70292
• System Dependent Data
– Data that is necessary for the transaction but is system
dependent
– Validation is on the existence of content
– Message control ID (MSH.10) is required, we validate that:
• MSH.10 is present
• Uncertain how to Categorize some Elements
– E.g., Patient ID; can NIST specify or is this system dependent?
– Ultimately this will be decided by the certification organization
– Spreadsheet and processing to feed the conformance tool will
allow for such latitude
– Categorized defines the granularity of the conformance checks

23
RXA Segment Layout in Test Procedure
Location Data Element ** System Comments Table # VXU 2 . 3 . 1 VXU 2 . 5 . 1
Dependent Usage Usage
Data
RXA-1 Give Sub-ID Counter   FIXED Value = 0   Required Required
RXA-2 Administration Sub-ID   FIXED Value = 1   Required Required
Counter
RXA-3 Date/Time Start of       Required Required
Administration
RXA-4 Date/Time End of   (if null, date/time   Required Required
Administration of start is
assumed)
RXA-5 Administered Code          
RXA-5.1 Identifier     HL70292 Required Required
RXA-5.2 Text       Required Required
RXA-5.3 Name of Coding System   FIXED Value = CVX   Required Required
or HL70292
RXA-6 Administered Amount       Required Required
RXA-7 Administered Units (ml,   If RXA-6 does not   Conditional Conditional
etc) equal 999 (unknown
amount) then this
field is required

RXA-15 Substance Lot Numbers       Required Required

RXA-17 Substance Manufacturer        
Name
RXA-17.1 Identifier     HL70227 Required Required
RXA-17.2 Text       Required Required
RXA-17.3 Name of Coding System   FIXED Value = MVX   Required Required
or HL70227

24
VXU Data Set in Test Procedure
Data Element Data Inclusion Indicator
ID Number 9817566735 Required
ID Number Type Medical Record Required
Family Name/Surname Johnson Required
Given Name Philip Required
Date of Birth May 26, 1984 Required
Administrative Sex/Gender Male Required
Race White Required
Ethnic Group Not Hispanic or Latino Required
Patient Address    
Street Address 3345 Elm Street Required
City Aurora Required
State Colorado Required
Zip Code 80011 Required
Country USA Required
Address Type Mailing Required
Telephone Number - Home 303-554-8889 Required
Vaccine Administration Information    
Vaccine Name Hepatitis A, Adult Required
CVX Code (for reference) 52
Date/Time Start of Vaccine February 24, 2010 Required
Administration
Administered Amount 10
1 :00AM Required
Administered Units ml Conditional
Vaccine Lot Number HAB9678V1 Required

25
RXA Segment/Data Layout in
Spreadsheet
Vaccine Segment         Immunizatio Immunizatio
n n
Data Element Test Data System Comments Table # VXU 2.3.1 VXU 2.5.1
Dependent Data
Give Sub-ID Counter 0   FIXED Value = 0   R R
Administration Sub-ID 1   FIXED Value = 1   R R
Counter
Date/Time Start of 201002241000       R R
Administration
Date/Time End of 201002241000   (if null, date/time   R R
Administration of start is
assumed)
Administered Code            
Identifier 52     HL70292 R R
Text Hepatitis A       R R
Name of Coding System CVX::HL70292   FIXED Value = CVX   R R
or HL70292

Administered Amount 1       R R
Administered Units (ml, etc) ml   If RXA-6 does not   C C
equal 999 (unknown
amount) then this
field is required

Substance Lot Numbers HAB9678V1       RMU-1 RMU-1

Substance Manufacturer Name            
Identifier SKB     HL70227 RMU-1 RMU-1
Text GLAXOSMITHKLINE       RMU-1 RMU-1
Name of Coding System MVX::HL70227   FIXED Value = MVX   RMU-1 RMU-1
or HL70227

26
Test Evaluation (Immunization
Example)
• VXU Message Structure
– Using based VXU HL7 level conformance profile
• Usage and Cardinality Requirements
– Based on the standard
– Additional constraints added for MU
– Applies to both NIST test data and system dependent
data
• Data Content
– Value set (CVX and others)
– NIST specified test data (e.g., exact CVX vaccine code)
– HL7 required content (e.g., message type)

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Need Feedback
• Review Test Procedures and Approach
• Review the elements that we selected to provide test data
• Specifically review RMU-1 decisions
– Implied criteria
– Evaluation assessment approach
• Review the test data
– Supplied
– System Dependent
• Review for both immunization and lab results
– Test Procedures available at: http://healthcare.nist.gov/
– Test data spreadsheet (under documentation), test
tool, value sets, conformance profiles, and
example messages based off test data is
available at:
http://xreg2.nist.gov:8080/HL7V2MuValidation2011/
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